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Doctors treated for addiction achieve good outcomes

Addiction

Addiction

Two studies carried out in the USA and Canada have found that doctors who seek help for their addiction make a good recovery.

In the US study, 802 physicians were followed up. The majority (87%) were men and the mean age at entry was 44 years. The predominant substance of misuse was alcohol (50%), with opioids second (36%). Over three-quarters of doctors included in the study (78%) had favourable outcomes and were licensed and working at the end of five years' follow up.

The Canadian study included 100 doctors, and 90% were men. The mean age at enrolment was 45 years, and alcohol misuse was the primary substance of misuse for 51%, with opioids second at 37%. A total of 85% of doctors successfully completed the five-year monitoring programme.

In their study of substance misuse treatment for US doctors, McLellan et al carried out a retrospective longitudinal cohort study of 16 physician health programmes. Overall the study evaluated the progress of 802 doctors over a period up to five years. A small majority of participants had been mandated to enter the programme by a licensing board.

A typical programme included 10 weeks' residential treatment followed by outpatient treatment while the doctor resumed work. The programmes were almost exclusively abstinence focussed and 12 step based, and use of pharmacotherapy was rare.

Participants were expected to attend treatment sessions, and were randomly tested for a range of substances including alcohol. Relapse and proven substance use resulted in re-evaluation and intensified treatment and monitoring, and possible reporting to the relevant licensing board.

Over an average 56 months of monitoring 81% of participants had no identified substance misuse, and at five-year follow up 78% were still employed in good standing.

The authors of the Canadian study followed up 100 doctors consecutively admitted to a substance misuse monitoring programme, and evaluated relapse during monitoring for five years. Before admission to the programme the doctors had been successfully treated and established in early stable remission, usually in an abstinence-based residential programme for 4-6 weeks. The ongoing treatment programme included the requirement to attend appointments and random screening of urine for alcohol and substances of misuse.

During the monitoring period 71% of participants had no known relapse, and an additional 14% went on to complete the programme after some form of relapse. In total 85% of doctors successfully completed the programme.

As a group, doctors may have more than their fair share of stress-related health issues, and studies from some countries have shown higher than average rates of substance use disorders. The response to doctors in difficulty has steadily moved from a disciplinary one to a therapeutic one. These studies show that in the US and in Canada, the large majority of physicians entering treatment and monitoring programmes for substance misuse have good long-term outcomes, achieve and maintain abstinence, and are able to continue their work as doctors.

McLellan AT, Skipper GS, Campbell M et al. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States BMJ 2008;337:1154-56

Brewster JM, Kaufmann M, Hutchison S et al Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study. BMJ 2008;337:1156-59

Reviewer

Dr Jez Thompson
Former GP, Clinical Director of Leeds Community Drugs Services

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